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Generally radiation alone can cure early cancers and is often an option to surgery. Traditionally patients with advanced cancers were generally treated with surgery followed by postoperative radiation (see section on postoperative radiation) Now many patients with advanced/ inoperable cancers are often treated with twice a day radiation (see section on hyperfractionation) or radiation combined with chemotherapy (see section on chemoradiation.) Typical radiation dose regimens as used by the RTOG are noted below: and as in H-0129.

Patients who relapse after full course radiation may be candidates for further radiation but it is very risky (see study) and RTOG 9911 and here.

There is an increasing number of oropharynx cancers caused by HPV infection (rather than smoking) and they have a better outcome ( go here and here).

See the E-medicine section on head and neck cancer here

Other references are noted below


stage system



 

Typical postOp Technique from the RTOG Trial:

PostOp radiation in stage III/IV cases (from RTOG 9703)

Radiation therapy should begin no earlier than post-op day (POD) 28 and no later than POD 42. Do not start radiation if there is major
fistula/wound dehiscence until significantly healed. Must be cleared surgically to start. Once daily (2 Gy/d) radiation therapy is given to a total minimum dose of 58 Gy and maximum dose of 64 Gy to involved areas, over 5.5 -6.5 weeks. The dose to any point within the spinal cord should not exceed 45 Gy.  Primary Tumor Bed Final dose (using shrinking field technique): Minimum 58 Gy to resected regions. Boost to 62-66 Gy for high-risk factors. Neck Lymph Nodal Bed Final dose (using shrinking field technique): Minimum 58 Gy to resected regions. Boost to 62-66 Gy for high-risk factors. Contralateral and other unoperated lymph node regions (Levels 1-5, and for pharyngeal cancers, the retropharyngeal lymph node region): 50 Gy
minimum dose.

 
tongue_nejm.jpg (5160 bytes) Typical Combined Chemo-Radiation Technique from the RTOG:

Advanced head and neck radiation combined with chemo (from RTOG 9703)

All treatment will be at 2 Gy per day. Uninvolved subclinical sites will receive 50 Gy / 25 fractions.Fields will be reduced to limit the spinal cord to = 44 Gy. Fields will be reduced a second time after 50 Gy to treat gross disease only an additional 20 Gy / 10 fractions at 2 Gy per fraction to a final dose of 70 Gy. Treatment will be continuous, 5 days per week for 7 consecutive weeks. Boost Doses: Additional boost doses may be given through reduced fields to persistent primary tumor and or clinically positive nodes. The boost dose should not exceed 5.0 Gy. The anterior low neck field will be treated at 2 Gy per fraction to 3 cm depth, once daily to a total dose of 44 Gy/ 22 fxs.